KENYA’S GIRLS NAVIGATE HIV RISK WITHOUT U.S. SUPPORT. Report by Victoria Amunga for Devex
KISUMU COUNTY, Kenya — Nineteen-year-old Sharon Akoth remembers the moment her ambition to become a doctor felt possible.
In 2021, she enrolled in the U.S.-funded DREAMS program, an initiative aimed at supporting adolescent girls and young women at high risk of HIV. Orphaned at age 12, Akoth had struggled to stay in school and relied on relatives in Kibos, a small town in Kenya’s Kisumu County, to cover school fees and meals. Frequent inability to pay for required supplies, such as books and uniforms, often forced her out of class. The DREAMS program, she said, changed that.
“It's through the DREAMS program that they gave me a school uniform, shoes, and they provided me with food, which I took home,” Akoth said.
She began looking forward to the weekends, when dozens of girls from her community gathered at the local social hall for DREAMS mentorship sessions. There, Akoth learned about sexual health, relationships, and how to protect herself from gender-based violence — topics her late mother never had the chance to discuss with her.
“I used to meet my peers during the forums … we would talk a lot. They were like family to me,” she said, noting that the program would also regularly distribute menstrual hygiene products because few of the girls could afford to buy them on their own.
Her routine ended abruptly in December 2024. After returning from their holiday break, Akoth and her peers were called into a January meeting where their trainer announced the sessions would not continue.
Akoth is among millions of girls and young women affected after the U.S. government halted its PEPFAR-funded DREAMS program across 15 countries, including 10 in sub-Saharan Africa. The initiative had reached more than 2 million adolescent girls and young women, focusing on HIV prevention, sexual and reproductive health and rights, protection from physical and sexual violence, education, and economic empowerment.
In Washington, D.C., the DREAMS termination was framed as a pragmatic trade-off: treatment and HIV testing could continue, officials argued, even if prevention programs were scaled back, according to a former State Department employee familiar with the conversations who requested anonymity out of concern for professional repercussions.
For Akoth, the loss extended far beyond canceled gatherings. Without the program, she dropped out of school and was forced to have sex with men to financially survive. She met a man, hoping he would help her buy sanitary towels and continue her education, but she became pregnant. When he learned of the pregnancy, she said, he left.
An architecture of prevention
DREAMS — short for Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe — functioned as a comprehensive support system for girls who were otherwise navigating risk largely on their own, said Nairobi-based women’s and children’s health advocate Maurine Murenga, founder of the Lean on Me Foundation a nonprofit that supports women living with HIV and those affected by tuberculosis.
Through small peer groups known as “sister cycles,” girls received mental health support, mentorship, and age-appropriate guidance on sexual health and HIV prevention, often from slightly older peers who had already navigated similar challenges.
Launched in 2014 with an initial commitment of $385 million, the DREAMS initiative was funded through PEPFAR — also known as the U.S. President’s Emergency Plan for AIDS Relief — in partnership with the Gates Foundation, Girl Effect, Gilead Sciences, Johnson & Johnson, and ViiV Healthcare. PEPFAR had invested over $1.6 billion in DREAMS goals since its inception, according to a 2022 report to the U.S. Congress.
It was an initiative credited for its success in driving reductions of 25% or more in new HIV diagnoses among adolescent girls and young women across nearly all of its geographic regions. The gains were especially significant in sub-Saharan Africa, where women and girls accounted for 62% of all new HIV infections in the region in 2023.
In Kisumu, 23-year-old Queenter Auma is still holding onto hope that the DREAMS program will return. Born HIV-positive, she depended on the initiative for consistent access to medication, counseling, and accompaniment to clinics, which helped shield her from stigma. She joined DREAMS after learning about the opportunity from representatives who went door to door in her village.
“I was living with my single mother, and she encouraged me to join the program,” Auma said. “They supported us in getting antiretrovirals. They helped me in paying [for school].''
The loss of the program has increased vulnerability for girls like Akoth and Auma, Murenga said. Beyond counseling and mentorship, the program was designed to address the structural factors that increased girls’ vulnerability to unplanned pregnancy and HIV — particularly poverty and school dropout — by helping keep girls in classrooms and supporting basic economic stability for those who had already dropped out.
Kenya recorded a 19% increase in new HIV infections in 2024, including an increase in Kisumu, where both Akoth and Auma reside. This trend will only worsen, Murenga said, with the termination of initiatives like DREAMS. Kenya does not yet have the capacity to sustain programs of the same scale without foreign assistance, leaving adolescent girls and young women exposed to HIV and teenage pregnancy.
What often goes unspoken, Murenga added, is that these trends translate into children acquiring HIV from their mothers. Based on data from Lean On Me, many of the children still contracting HIV are born to teenage mothers who were newly infected.
“A 14-year-old still doesn't know how to take care of herself,” she said. “And then you shock them with the HIV infection? They don't even know what to do about the HIV infection. They're still dealing with this pregnancy.”
Filling the void
There is no movement within the U.S. government to revive the DREAMS program, according to the former State Department employee. Yet several of the administration’s stated priorities — including expanding access to new HIV treatments such as long-acting antiretroviral lenacapavir and reducing mother-to-child transmission — are unlikely to be met without the prevention and support systems DREAMS once provided.
“You’re not going to reach your HIV-related targets or policy goals if you ignore that certain populations are more vulnerable than other populations, or the cultural norms that play into that,” the employee told Devex.
To address the gap in Kenya, the National AIDS and STIs Control Program, or NASCOP, under the country’s Ministry of Health, has launched an effort to train health care workers to provide adolescent-friendly sexual and reproductive health services. NASCOP program manager Elizabeth Nailantei said the focus has been on building provider capacity, with trainers now trained in 26 counties, including in Kisumu, where Akoth and Auma live.
Nailantei acknowledged that the effort falls far short of replacing DREAMS. NASCOP won’t be able to fill the void left by the abruptly defunded social programming and economic support, for example, but “we can empower the health providers to be able to offer those [adolescent and young people]-friendly services that they were not offering before,” she said. This includes things such as free counseling services, the provision of contraceptives, and creating safe spaces so that vulnerable populations at risk of stigmatization don’t have to queue with the rest of the public for services.
Several health professionals familiar with the program said it has always been an expensive model that would be difficult for countries to replicate or sustain with domestic resources alone.
Emily Bass, a public health advocate and coauthor of a Physicians for Human Rights report, told Devex that while comprehensive HIV prevention for adolescent girls and young women remains essential for long-term success, the program has not yet been replaced in countries such as Uganda and Tanzania.
“It is urgent to work with impacted communities to identify and fund gaps with programs that reduce HIV risk for people who do not have HIV and ensure long, healthy, stigma-free lives for people who do,’’ she said.
With the exit of the DREAMS program, girls who once relied on its support are trying to move forward without it, even as they hope it will return. Right now, survival depends on informal or low-paid work. Akoth, now a mother, earns a small income at a local bicycle repair shop, a sharp departure from her ambition to become a doctor.
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